Antibiotic prophylaxis for open fractures: Difference between revisions
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** Consider adding anaerobic coverage |
** Consider adding anaerobic coverage |
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** For example, one Ontario trauma center uses '''[[Is treated by::cefazolin]], [[Is treated by::tobramycin]], and [[Is treated by::metronidazole]]''' |
** For example, one Ontario trauma center uses '''[[Is treated by::cefazolin]], [[Is treated by::tobramycin]], and [[Is treated by::metronidazole]]''' |
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** Add high-dose penicillin to cover [[Clostridium |
** Add high-dose penicillin to cover [[Clostridium]], in the presence of fecal contamination or farm-related injuries |
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** [[Fluoroquinolones]] should be avoided, if possible, due to slowing bone healing |
** [[Fluoroquinolones]] should be avoided, if possible, due to slowing bone healing |
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* '''Duration''' |
* '''Duration''' |
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Latest revision as of 02:52, 8 February 2022
Gustilo Classification
- Type I: open fracture with skin wound <1cm in length and clean
- Type II: open fracture with a wound >1cm in length without extensive soft tissue damage, flaps, or avulsions
- Type III: open segmental fracture with a wound >10cm in length with extensive soft tissue injury or a traumatic amputation
- IIIA: adequate soft tissue coverage
- All farm injuries and gunshots are automatically at least IIIA
- IIIB: significant soft tissue loss with exposed bone that requires soft tissue transfer to achieve coverage
- IIIC: associated vascular injury that requires repair for limb preservation
- Special categories:
- gunshot injuries
- any open fracture caused by a farm injury
- any open fracture with accompanying vascular injury requiring repair
- IIIA: adequate soft tissue coverage
Risk of Infection
- Type I: 0%
- Type II: 2%
- Type III: 6-44%
- Type IIIA: 2%
- Type IIIB: 11%
- Type IIIC: 20%
Management
- Don't forget tetanus!
- Antibiotic choice
- Cover Gram-positives as soon as possible after injury, e.g. with cefazolin
- Add Gram-negative coverage for type III fractures, e.g. with tobramycin
- Consider adding anaerobic coverage
- For example, one Ontario trauma center uses cefazolin, tobramycin, and metronidazole
- Add high-dose penicillin to cover Clostridium, in the presence of fecal contamination or farm-related injuries
- Fluoroquinolones should be avoided, if possible, due to slowing bone healing
- Duration
- Continue for 24 hours after wound closure
- If type III, continue for at least 72 hours post-injury if Type III
Further Reading
- Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 Jun;58(4):453-8. pmid: 773941
